Prescribing decisions in the institutional setting differ considerably from the retail setting. As noted in the figure below, HCPs are influenced by several parties, both internal and external. While the health of the patient and safety of medications continue to be of paramount importance, over the past several years, financial considerations have increased attention on quality of care. No longer is a hospital’s survival dependent on the “hotel model” (where higher occupancy equals greater profitability), rather insurance companies, in an effort to control costs, are incentivizing institutions (IDNs) to keep patients healthy, reduce the length and frequency of hospitals visits, etc. Further, as new information systems and technologies are implemented (many driven by requirements outlined in the Affordable Care Act) the ability of key payers to manage costs and processes will improve. This will continue to drive the behaviors of healthcare professionals and their employers.